John Matthew Tan Modina, PT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

64474 Issued in OR

Practice address

332 NE San Rafael St
Portland, OR 97212-3948

Phone

(503) 288-2615

NPI assigned

May 27, 2022

Last updated

May 27, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• True Sports Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Baltimore, MD
  • NPI 1114357340

  Orthopedic

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1962141085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10804 NE 44TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986826610",
            "telephone_number": "360-949-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 NE SAN RAFAEL ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972123948",
            "telephone_number": "503-288-2615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODINA",
        "first_name": "JOHN MATTHEW",
        "middle_name": "TAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-27",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "OR",
            "license": "64474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Modern Mindful Psychotherapy
• Modern Nutrition NW LLC
• Autumn Jennifer Modest
• Nir Modiano, MD, PHD
• Rachel Marie Modica-Russell
• Emily Modlin, BA
• Modus Vivendi LLC
• Tina Qian Hong Mody, PHARMD
• Kyla Dawn Moe-Stull
• Sally Marie Moeggenberg, MPT

• Orthopedic Physical Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Orthopedic Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.